Wednesday, April 4, 2012

How to be a Fast Resident

When I was a resident, I prided myself on being super fast. On the busiest rotations, I always managed to leave at a reasonable time. These are some of the tips I have for those of you who want to be as speedy as me:

1. Never do something twice. If you have something that needs to be written, only write it once. That refers to writing orders, or if you're doing an H&P, take notes from the patient on the actual H&P form. If you can help it, never use a scrap paper as an intermediary.

2. Multitask: If you're making a phone call, you should also be writing a note and eating lunch at the same time. If you're only doing one thing, you're being too slow.

3. Don't get too caught up on details. If you leave something minor out, the patient won't die. But you might be at work till midnight every day if you obsess over leaving something out. Remember that there's an attending, a pharmacy, and a nursing staff to catch mistakes.

4. Checkboxes: Is there anything checkboxes can't do? If you make checkboxes for everything you need to do on Mr. Smith, you won't be searching for his chart 30 minutes later when you realize you forgot to order his AM labs.

5. Interrupt patients. If you don't know how to redirect a patient properly, you will never leave work ever again.

6. Talk fast. Nobody's listening anyway, so you may as well say what you need to say as fast as possible.

7. Show up late to conferences. If you show up on time, you'll be staring at the wall for a guaranteed wasted 15 minutes and also look like a total loser.

8. Never show up early. To anything. Especially to work. I've noticed that when I come in earlier, I end up just doing everything more slowly and finish at the same time.

Most important though is to learn when you need to not go too fast, even when things are crazy busy. Like when an opportunity came up for education, either being on the giving or the receiving end, I'd always make time.


  1. A lot of these suggestions apply to nursing staff, as well. Especially the multitasking advice. I actually figured that one out on my own and it has helped me tremendously. A great technique I have found for finding a way to leave the room is to say something funny and make them laugh- and then leave while the pt. and/or family is laughing. I believe George from Seinfeld called it "leaving on a high note".
    I also agree on the showing up early thing. There are two nurses in particular who show up an HOUR early for EVERY shift and print out every patient's entire med list. Theses nurses are also the ones that will call docs for every. little. thing. Like for hold parameters on lopressor.("Dr.! The patient's BP is 75/38, should I give it? There's no hold parameter... What, Dr.?? A bolus? I just wanted to know a hold parameter, I didn't say anything about a bolus.." :/ ) They always leave late, too. And even though they are both long time nurses, if either of them were ever put in charge, their heads would explode. Anyway, great entry. I might make a similar one for nurses. :)

  2. It's nice to know residents are keeping pharmacists employed ;)

  3. 2 minutes into Idol, and I can't stop staring at Ryan Seacrest's lips. I don't know what's wrong with them. Like someone did a bad lipstick job. And they look a bit puffy.

  4. Do what the neurosurgeons do to save time: write chart notes without going to see the patient.

  5. "Most important though is to learn when you need to not go too fast, even when things are crazy busy. Like when an opportunity came up for education, either being on the giving or the receiving end, I'd always make time." - you don't know HOW grateful I am for doctors who teach (and, although a little bit useless at this stage - how I enjoy teaching/helping those in the years below me)... I love this! :-) :-) :-)

  6. 9. Never ever EVER pick up a phone even if you're the only person in the room where it's ringing.

    1. Yes Yes Yes
      Learned my lesson after picking up the phone in the residents' room in the psych ER, 10 seconds after coming on to shift: "How DARE you discharge my daughter when she's saying she'll kill herself!!!??" No amount of "M'am, I just came on, M'am, I didn't even meet your daughter, let alone discharge her, M'am, can I find someone more familiar with your situation to talk to" would stop the barrage of verbal abuse. First and last time I answered a phone call I was not expecting.

  7. With all due respect to you, Doctor, this is a most appallingly unprofessional list.

    #1, okay. Good advice for everyone.
    #2, well, studies have repeatedly shown that people think they're better at multitasking than they actually are. Writing notes while you're on the phone will inevitably lead you to miss what the caller is saying, and mistakes in your notes. Which leads me to...

    #3, which leads me to question your overall fitness to practice. What happens when everybody assumes that someone else will catch their mistakes? In fact, there IS someone who will catch everyone else's mistakes -that person is called a "patient", who may have a fatal reaction to a particular combination of drugs, or may have the wrong leg amputated, or may have to take a series of unnecessary tests, or just be scared out of his mind because you are all assuming that someone else will catch your mistakes. The job of a professional is first and foremost to ensure that he or she is delivering quality care, not fast care.

    #4 Checkboxes lead to linear, non-creative thinking because you start relying on the checkbox to think for you. Sometimes, you need to think outside the checkbox. So yes, there are some things checkboxes can't do.

    #5 Yes by all means direct the patient to stay focused. But interrupting someone because they aren't following your narrative precisely will cause you to miss details that may be vitally important, but didn't occur to you initially.

    #6 If no one's listening to you, that's your problem, not theirs. It's not like you have a quota of words you have to speak each day; words are the essence of communication. If no one's listening, think about why, and come up with ways to make what you say matter. Speaking faster isn't ever a productive strategy.

    #7 displays a shocking lack of respect for other people. If that's your attitude toward your colleagues, what attitude are you taking with your patients? I agree that it's annoying to wait around for other people, but if that's the case, isn't it just as annoying to other people when they have to wait around for you? Or are you more important than everybody else?

    #8 says a lot about you, but doesn't support a generalized rule. On the other hand, if you showed up early, maybe you could help out someone else who is overworked and tired at the end of his or her own shift. Maybe it's not "more efficient" or "faster", but hey, it might even set a tone of helpfulness and collegiality among your colleagues that results in better patient care. Wouldn't that be interesting!

    And finally, if you're rushing around, multitasking and cutting corners all day, how would you even know a teachable moment was happening? Sorry doc, but if I ever find myself needing quality medical care, your hospital is the last place I would look.

  8. Finally.... I was wondering when someone was going to call me on this post.

  9. i'm a medical student. in a few year's time i will become a dr.

    in all seriousness, i think i have short term memory problems... i'm no good in directions too.

    i just want to ask how do doctors know almost everything about their patient.. fair enough if it is just one, but they have many to care for so how do they remember so much about them? (e.g. if a consultant asks for the bloods, the juniors can instantly recall)

    how do u get urself so organised... thanks! practical tips most appreciated!!!! :(

  10. Dangboby: I think part of the reason doctors are better at remembering everything than med students are is that they actually aren't. As you go futher in your training, you become better at realizing what's important. So instead of remembering all the patient's labs, they recognize that the one piece of data that's important in a particular patient is, say, the hematocrit and that's much easier to remember. The more you understand, the more you remember.

  11. Number 3 and 5...really? Just quit before you lose your career and you'll save lots of time.

    1. You must not be a physician. If you are and you don't know how to properly redirect a patient, then I feel sorry for you (and your patients).